Keywords

Introduction

The growth of the Latino population over the last half century has been phenomenal. The Latino population shifted from a relatively small homogeneous group concentrated in selected parts of the country to a large diverse population found throughout the nation [1]. Latinos became the nation’s largest minority population in 2003. Even though the pace at which the Latino population grew in the last couple of decades has decreased somewhat, Latinos continue to account for the majority of growth in the United States today and in the coming decades [1].

In the process, the prominent growth of Latinos has been associated with their impact on changes taking place in societal institutions and a wide variety of national trends. For example, higher education institutions in considering their futures need to incorporate Latino students into their student recruitment plans as the number of White students in the traditional college-attending ages has plummeted alongside recent declines among Black students [2]. In addition, business leaders have devoted a growing amount of attention to Latino consumers as their population and purchasing power have grown [3, 4]. Furthermore, the significant augmentation of the Latino population is linked to changes in other settings as well. One of these domains is in the area of health outcomes, including the incidence and mortality associated with cancer. As is the case with other groups, cancer is the leading cause of death of Latinos today [5]. Nonetheless, consistent with the Latino paradox, Latinos have lower death rates from cancer compared to Whites and other racial and ethnic groups [6, 7], the exception being certain types of cancers associated with infectious disease, including liver, stomach, and uterine cervix cancer [5, 8]. Even though Latinos are relatively more protected from cancer than other groups, their disproportionate growth is likely to contribute to the shifting demography of cancer [8].

This chapter examines the relative growth of Latinos among persons who developed cancer and those who died from it in the recent past and in the future. The next section illustrates the demographic context that serves as the backdrop for the rising importance of Latinos in the shifting demography of cancer. The chapter concludes with a discussion of the public policy implications of the results.

The Demographic Context

We highlight here the dynamics that produced the major growth of Latinos over the last several decades. Between 1980 and 2019, the Latino population more than quadrupled from 14.6 to 60.6 million [9, 10]. Over the same period, the White population rose by only 9.5%. Latinos increased their percentage share of the nation’s population from 6.4% in 1980 to 18.5% in 2019 while that of Whites fell from 79.6% to 60.1%. The disparate growth of Latinos and Whites has been driven by a youthful Latino (median age of 22 in 1980) and an older White (median age of 31 in 1980) population. Furthermore, during the period of examination below (1999–2016) regarding the analysis of changes in cancer cases and deaths, Latinos primarily drove the nation’s demographic change. Indeed, of the 46.8 million people that the United States added to its population between 2000 and 2019, Latinos accounted for the majority (54.0% or 25.3 million) and Whites constituted only a sliver of the growth (5.9% or nearly 2.8 million) [10, 11].

Latinos today continue to be a younger population than Whites. For example, in 2018 the median age of the Latino population was 29 compared to 43 for the White population; persons less than 18 years of age accounted for 31% of the Latino population compared to 19% of the White population; and persons 65 years of age and older made up 7% of Latinos but 20% of Whites [12]. The youthfulness of the Latino population will again impel future change in the US population. For example, the latest population projections from the US Census Bureau show that the Latino population is projected to almost double from about 57.5 million in 2016 to 111.2 million in 2016. In contrast, the White population is projected to decline from 198 to 179.2 million, a 9.5% decrease [13]. Undoubtedly, the dominating growth of the Latino population will shift the demography of people who develop cancer or die from it.

Data and Methods

The analysis conducted is based on two time periods—a look at the past between 1999 and 2016 and a look into the future between 2016 and 2060. First, the analysis uses information from the US Cancer Statistics public data [14] to obtain the number of cancer cases and deaths alongside the respective age-adjusted cancer incidence rates (number of persons with cancer per 100,000 persons) and age-adjusted death rates (number of deaths from cancer per 100,000 persons) for each year between 1999 and 2016 for Latinos and for two comparison groups: non-Hispanic Whites and non-Hispanic Blacks (referred to as simply “White” and “Black” below). These data were used to assess variations across Latinos, Whites, and Blacks in the growth of cancer cases and deaths between 1996 and 2016.

Second, the analysis subsequently turns to the projection of cancer cases and deaths into the future (2016–2060) to examine the impact of the projected growth of the Latino population on the changing demography of cancer over the next four decades. This exercise involves two sets of data: the latest 2016 age-specific cancer incident rates (CIRs) and cancer death rates (CDRs) per 100,000 for Latinos and the total population obtained from the US Census Statistics public data [14] and the US Census Bureau’s age–sex-specific population projections for Latinos and the total population [15]. Essentially, the projected cancer cases and deaths for Latinos and the total population assume that the CIRs and CDRs observed in 2016 remain constant over time between 2016 and 2060 and these are applied to the projected Latino population and the total population for 2020, 2030, 2040, 2050, and 2060. The projected Latino cancer cases and deaths for each specific year are obtained from the following formulas:

$$ {\displaystyle \begin{array}{c}{\textrm{PRJCI}}_i=\left({\textrm{CIR}}_i/100,000\right)\ast {\textrm{PRJPOP}}_i\\ {}{\textrm{PRJCD}}_i=\left({\textrm{CDR}}_i/100,000\right)\ast {\textrm{PRJPOP}}_i\end{array}} $$

where i represents a given age category (0–14, 15–24, 25–34, 35–44, 45–54, 55–64, 65–74, 75–84, and 85 and older). The projected number of age-specific cancer cases (PRJCIi) and cancer deaths (PRJCDi) are obtained by multiplying the age-specific proportion format of the cancer incidence rate (CIRi/100,000) and the cancer death rate (CDRi/100,000), respectively, by the age-specific population projections (PRJPOPi). The same formulas are used to generate the projections for the total cancer cases and deaths to determine the percentage share of future growth in cancer cases and deaths that would likely be Latino. Obviously, it is unlikely that the age-specific cancer incidence and death rates would remain unchanged over the course of the next 44 years (2016–2060). However, we use the latest rates to illustrate how the demography of cancer could change over the next four decades given the growing Latino population.

Results

An Examination of the Recent Past

The incidence of cancer changed significantly between 1999 and 2016. While the age-adjusted cancer incidence rates (AACIRs) declined for all three racial and ethnic groups, the number of cancer cases increased across all of the groups. Yet, consistent with the demographic context illustrated above, the number of cancer cases more than doubled for Latinos from 67,955 in 1999 to 139,976 with those of Blacks rising by 50% and by 17.5% for Whites (Table 10.1). The overall number of cancer cases in the nation increased by 382,545 between 1999 and 2016. Of the total national growth, Latinos made up approximately 19% of the total increase in the incidence of cancer between 1999 and 2016, with Whites responsible for 50% of the growth and Blacks for 16%. Overall, the share of the incidence of cancer in a given year increased somewhat for Latinos from 5.1% in 1999 to 8.2% in 2016, while it decreased for Whites from 82.7% to 75.5%.

Table 10.1 Demographic changes in cancer cases and deaths between 1999 and 2016 [14]
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As is the case with the incidence of cancer, cancer death rates declined between 1996 and 2016, but the absolute number of deaths increased across the three groups. The relative increase of cancer deaths, however, was less for cancer deaths (9%) than for cancer cases (29%). As such, the increase in the volume of deaths among Latinos stands out, nearly doubling from 20,233 in 1999 to 39,263 in 2016. In contrast, the number of cancer deaths increased by only 2% for Whites and 14% for Blacks. Overall, there was an increase of 48,202 cancer deaths in the country between 1999 and 2016 with Latinos accounting for about 40% of the growth compared to 21% for Whites and 17% for Blacks.

Several observations to note include:

  • Latinos have the lowest age-adjusted cancer incidence rate and cancer death rate compared to Whites and Blacks.

  • The incidence of cancer more than doubled and the number of cancer deaths nearly doubled between 1999 and 2016 among Latinos largely due to their major population growth.

  • Latinos disproportionately accounted for the nation’s growth in cancer cases (one-fifth) and cancer deaths (two-fifths) between 1999 and 2016.

  • Latinos continued to comprise only a fraction of all cancer cases (8.2%) and deaths (6.6%) in 2016. These trends are expected to intensify with the major population growth that Latinos will experience over the coming decades.

An Examination of the Future

The growth of the Latino population will have a mark on the changing face of people with cancer in the coming decades. The projected incidence of cancer among Latinos is expected to grow 3.5-fold from 139,000 in 2016 to 480,000 in 2060, with their projected deaths more than quadruple from 39,000 to 168,000 (Fig. 10.1). The respective growth is more gradual among non-Latinos at 43% in projected cancer cases and 68% in deaths. It is expected that Latinos would account for one-third of the US-projected increase in cancer cases and one-fourth of that in cancer deaths.

Fig. 10.1
A line graph projected cancer cases and deaths from 2016-2060. The lowest cases projected in 2016 is 1,40,000, the highest is 4,90,000 in 2060, death projected is 40,000 in 2016, and 1,80,000 in 2060. Values are estimated.

Projected Latino cancer cases and deaths, 2016–2060 [14, 15]

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The Latino percentage share of the nation’s incidence and deaths associated with cancer annually is likely to more than double between 2016 and 2060, with the portion of cases that are Latino rising from 8.1% in 2016 to 17.6% in 2060 and that of deaths climbing from 6.5% to 15.2% (Table 10.2). The doubling of the percentage share of Latinos among persons with cancer is expected at ages 45 and older, reflecting the aging of Latinos in the coming decades. By 2060, roughly one of six persons with cancer or who die from it are expected to be Latino. As Latinos will continue to be younger than other groups, they will make up a larger share—approximately one in four—of cancer cases and deaths among persons less than 45 years of age in 2060.

Table 10.2 Percentage share of Latinos of all projected cancer cases and deaths by age group, 2016 and 2060 [14, 15]
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Conclusions

As Latinos have driven the nation’s changing demography, they are also playing a disproportionate role in the changing demography of cancer over the last 18 years and will do so even more in the next four decades. Cancer researchers, medical personnel, and health providers will need to devote more attention to the growing presence of Latinos among the people they study, treat, and care for. There is a need to better understand the diversity that marks the Latino population along the lines of generational status, gender, nationality, and socioeconomic status.

The findings presented here have implications for public policy. For example, Latinos have the highest percentage of people without health-care insurance with approximately one-fourth of persons 18–64 years of age lacking this basic necessity [12]. The absence of insurance increases the risk of cancer and of dying from the disease. In addition, public policy promoting the rising detention and deportation of Latino undocumented migrants is related to a major decline in the volume of migration from Mexico to the United States over the last decade [16]. This descent of newcomers from Mexico could potentially lead to the erosion of the morbidity and mortality advantages that Latinos have maintained over decades [6, 7].

In conclusion, in the current coronavirus pandemic, Latinos who suffer from cancer are at high risk of contracting and succumbing to the virus. The incidence of cancer is also likely to surge after the pandemic as doctor visits and annual checkups become more regular.